Mnet Health News delivers the latest news and information articles for the world of healthcare.

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What Keeps You Up at Night?

The cost of healthcare in the United States is a significant source of apprehension and fear for millions of Americans, according to a new national survey conducted by West Health and Gallup. With over $3.5 trillion—nearly one-fifth of the nation’s gross domestic product — spent in 2017 alone, the national poll indicates this financial burden causes a multitude of worries and anxieties for a large segment of American adults.

These findings were published in a report titled “The U.S. Healthcare Cost Crisis,” based on a nationally representative survey of more than 3,500 American adults on the impact of the high cost of healthcare on personal finances, individual healthcare choices and the level of satisfaction with the U.S. healthcare system.

Relative to the quality of the care they receive, the study revealed that Americans overwhelmingly agree they pay too much, receive too little, and have little confidence that elected officials can solve the problem.  Americans in large numbers are borrowing money, skipping treatments and cutting back on household expenses because of high costs, and a large percentage fear a major health event could bankrupt them. 

More than three-quarters of Americans are also concerned that high healthcare costs could cause significant and lasting damage to the U.S. economy.  Despite the financial burden and fears caused by high healthcare costs, partisan filters lead to divergent views of the healthcare system at large: By a wide margin, more Republicans than Democrats consider the quality of care in the U.S. to be the best or among the best in the world — all while the U.S. significantly outspends other advanced economies on healthcare with dismal outcomes on basic health indicators such as infant mortality and heart attack mortality.

Republicans and Democrats are about as likely to resort to drastic measures, from deferring care to cutting back on other expenses including groceries, clothing, and gas and electricity. And many do not see the situation improving.  In fact, most believe costs will only increase. When given the choice between a freeze in healthcare costs for the next five years or a 10% increase in household income, 61% of Americans report that their preference is a freeze in costs.  Other key survey findings include:

77% of Americans are concerned rising costs will significantly damage the U.S. economy.

76% expect their costs for healthcare will increase even further in the next two years.

15 million Americans have deferred purchasing prescription drugs in the past year due to cost.

Nearly 3 million borrowed $10,000 or more to pay for healthcare in the past year.

Only about one-third report that doctors discuss costs with them in advance of procedures, tests or treatment plans, or for medicine required to treat their conditions.

The New York Times published an article titled, “Americans Borrowed $88 Billion to Pay for Health Care Last Year, Survey Finds,” that provides an in-depth analysis of the survey. In the piece, reporter Karen Zraick notes that West Health and Gallup will conduct similar studies going forward.

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HHS Payment Model Designed to Meet Beneficiaries’ Emergency Needs

Supporting ambulance triage options aims to allow beneficiaries to receive care at the right time and place.  Earlier this year, the U.S. Department of Health and Human Services (HHS), Center for Medicare and Medicaid Innovation (Innovation Center), which tests innovative payment and service delivery models to lower costs and improve the quality of care, announced a new payment model for emergency ambulance services.   It aims to allow Medicare Fee-For-Service (FFS) beneficiaries to receive the most appropriate level of care at the right time and place with the potential for lower out-of-pocket costs, a press statement released by HHS said.

The new model known as the Emergency Triage Treat and Transport (ET3), will make it possible for participating ambulance suppliers and providers to partner with qualified health care practitioners to deliver treatment in place (either on-the-scene or through telehealth) and with alternative destination sites (such as primary care doctors’ offices or urgent-care clinics) to provide care for Medicare beneficiaries following a medical emergency for which they have accessed 911 services. 

In doing so, the model seeks to engage health care providers across the care continuum to more appropriately and effectively meet beneficiaries’ needs. Additionally, the model will encourage development of medical triage lines for low-acuity 911 calls in regions where participating ambulance suppliers and providers operate. The ET3 model will have a five-year performance period, with an anticipated start date in early 2020.

The ET3 model encourages high-quality provision of care by enabling participating ambulance suppliers and providers to earn up to a 5 percent payment adjustment in later years of the model based on their achievement of key quality measures. The quality measurement strategy will aim to avoid adding more burden to participants, including minimizing any new reporting requirements.

Qualified health care practitioners or alternative destination sites that partner with participating ambulance suppliers and providers would receive payment as usual under Medicare for any services rendered. The model will use a phased approach through multiple application rounds to maximize participation in regions across the country.

To ensure access to model interventions across all individuals in a region, CMS will encourage ET3 model participants to partner with other payers, including state Medicaid agencies.  CMS anticipates releasing a Request for Applications this summer to solicit Medicare-enrolled ambulance suppliers and providers. In Fall 2019, to implement the triage lines for low-acuity 911 calls, CMS anticipates issuing a Notice of Funding.

There is an opportunity for a limited number of two-year cooperative agreements, available to local governments, their designees, or other entities that operate or have authority over one or more 911 dispatches in geographic locations where ambulance suppliers and providers have been selected to participate. For more information, please visit: https://innovation.cms.gov/initiatives/et3/ and https://bit.ly/2Ii9ZQD.

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How Insurance Coverage Impacts Consumers’ Ability to Pay

How Insurance Coverage Impacts Consumers’ Ability to Pay

New data on health insurance in the U.S. from The Commonwealth Fund reflects quality of coverage and the impact of coverage levels on consumers’ ability to pay medical bills and access care.  

Among the findings in the Biennial Health Insurance Survey, The Commonwealth Fund reports that consumers who are “underinsured,” meaning they carry high health plan deductibles and out-of-pocket medical expenses compared to their income, are more likely to have challenges paying their medical bills or avoid medical care because of the expense.

Twenty-nine percent of insured adults qualified as “underinsured” in 2018, an increase from 23 percent in 2014.  “U.S. working-age adults are significantly more likely to have health insurance since the ACA [Affordable Care Act] became law in 2010. But the improvement in uninsured rates has stalled. 

In addition, more people have health plans that fail to adequately protect them from health care costs, with the fastest deterioration in cost protection occurring in employer coverage,” said Sara Collins, lead author of the study and The Commonwealth Fund vice president for health care coverage and access, in a news release.

The survey offers a big-picture look at consumers’ health insurance, including the quality of their coverage, in 2018.

Key findings in the survey include:

Twenty-eight percent of U.S. adults who have health insurance through their employer were underinsured in 2018, an increase from 20 percent in 2014.

Consumers who purchased plans on their own through the individual market or the marketplaces were the most likely to be underinsured, with 42 percent reporting a lack of adequate coverage in 2018.

Forty-one percent of underinsured adults reported they held off on care they needed because of the expense, compared to 23 percent of consumers with “adequate insurance coverage.”

And, 47 percent of underinsured adults said they had medical bill and debt problems, compared to 25 percent of consumers who are not underinsured reporting these challenges.

More information: https://bit.ly/2GAEZsT

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3 Tips for Working with RCM Partners to Handle Self-Pay Patients

Patient balances present one of the most significant challenges in healthcare especially for surgery centers. With ever-rising healthcare costs, ambulatory surgery centers (ASC’s) see an increase in the number of patients that have high deductible health insurance plans. Patient obligations have increased 29.4 percent since 2015, and many are finding it difficult to pay off their medical bills and large out-of-pocket costs.

ASC’s invest significant resources and time to settle overdue payables from patients who are unable to manage paying off their medical bills. Many surgery centers find themselves reaching out to patients, sending letters, emails, and calls in an effort to collect from self-pay patients. 

However, collecting from patients is not naturally the expertise of a healthcare facility, so surgery centers often get the help of an RCM (revenue cycle management) partner or collections vendor.

How can your ASC work more effectively with its RCM partners to handle self-pay collections? What do you need to look for in selecting a third-party collections partner? Here are 3 tips to consider:

1. Implement Digital Payment Transmissions 

Interestingly, the increase of high-deductible plans has also coincided with the trend of healthcare consumerism. Patients now expect that they can pay their bills and manage their accounts online from their mobile phones or desktops. 

Surgery centers can work with their RCM partners to step up their game and make it easy for patients to register by tablet and pay electronically and get payment in advance for elective procedures. 

With self-pay patients, it is important to choose partners that are able to offer automatic enrollment in payment plans and financial counseling to avoid revenue leakage. 

2. Leverage Automation Technology

By its nature, self-pay accounts are risky. The cost to collect could reach up to three times higher than on commercial insurance accounts. The longer a self-pay balance goes unpaid, the harder and costlier it is to collect it.

This is why automation is becoming the new standard in revenue cycle management. Choose partners that can use automation to step up collection efforts of past due medical debts, decrease human error, maximize productivity, reduce costs, and streamline processes.

Here are four essential areas that needs vendor automation especially for self-pay accounts:

Daily accounts submission

Daily payment and adjustment account reconciliation

Vendor collections automatically directed to existing merchant services

Automatic invoices that are gross remit and auto-paid 

3. Focus on Personalization: Patient-Centric Financial Experiences  

With the help of your RCM partner and the use of technology, your facility can gain visibility into patient payment behavior and identify trends, bottlenecks, and needs. A one-size-fits-all approach doesn’t work with self-pay accounts. Hence the need for better personalization.

Here are some areas to focus on to create patient-centric financial experiences:

Improve medical bill (eliminate areas of confusion) 

Using price transparency tools

Patient education strategies

Flexible payment methods

Patient financial advocates

Having trained and patient-friendly staff (front-end and collections)

Better patient communications

The key to better personalization is using technology and training your staff. Work with your RCM partner to have full visibility into where all payments are coming from and have daily activity reports on all types of payments received, categorized according to account number, source of payment, etc. By having a 360-degree view of patient payment behavior, your ASC can create strategies that would personalize self-pay collections and achieve higher success rates.

 

 

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Patients Prefer Payment Plans for Medical Bills



As out-of-pocket health care costs continue to increase for consumers, more prefer payment plans to manage their medical bills, according to the “Changing Landscape of Health Care Payment Plans” report, produced by
PYMNTS in collaboration with Flywire. Data on the report is based on a survey of 2,837 patients who checked
into a hospital or emergency room in the previous year.

Key findings include:

57 percent of respondents would prefer a payment plan offered before service or at the time of service with their health care provider.

35.5 percent would prefer a payment plan offered at the time they receive their first bill.

Just 6.9 percent choose a phone call from their provider to ask for a plan.

There is a direct relationship between a patient’s increased out-of-pocket payments and the chance they will sign up for a payment plan:

38.9 percent of respondents used payment plans to manage out-of-pocket expenses ranging from $50 to $250.

When costs topped $1,000, 51.4 percent opted for payment plans.  Payment plan fees influence how patients make decisions connected to payment plans, for example:

33.7 percent choose shorter terms to reduce fees.

17 percent pay balances in full to avoid fees.

25 percent say fees have no influence on their decision on how to pay.

“The study offers important insights for hospitals and health systems seeking to optimize their revenue cycle practices and payment plan strategy, as well as to improve payment behavior without jeopardizing the relationship between patient and provider,” John Talaga, executive vice president, Flywire, said in a news release on the study.  More information: https://bit.ly/2CDJMpH

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Why a Patient Friendly Billing and Payment System Matters

 



To boost your bottom line, it may pay to consider patient consumerism when dealing with your patients. Because when a patient schedules a visit for medical care, they’re not simply thinking about the quality of care. They’re thinking about the value they’re getting from the visit, even if they have medical insurance coverage. Here are some of the realities patients and care providers are facing in regards to patient consumerism:

In the past decade, high-deductible health plans have become the norm for millions of Americans, meaning your patients’ out-of-pocket expenses cover the gamut, from $1,350 for individuals to $13,300 for families.  That means even with tools like health savings accounts, patients are more watchful than ever over their health care dollars.

Some of the struggling patients are young: Patients in their late 20s were more likely to have medical debt in collections than older patients, despite the fact they were less likely to use medical services, according to a 2018 study published in Health Affairs. Another surprise: Half the accounts in collections were for less than $600.

Three-quarters of a percent of health care providers saw a rise in patient responsibility for payments in 2015, according to a report in Rev Cycle Intelligence. And health care providers aren’t recovering the full balance from the patient but recouping 50-70 percent of the billable amount.  To work within these new realities, health providers can take proactive steps to make access to medical care more patient-friendly, and one area of focus could be in the realm of billing and collections.

Better front-end procedures: When a patient goes about their daily lives, they have become accustomed to completing many transactions online or with a smartphone app, whether they want to apply for a new job, shop for necessities, order food, get a ride, buy concert tickets, or transfer funds. When a patient wants to see a doctor, patients are still picking up the phone to book appointments and filling out paper forms in the waiting room.

Offering an online scheduling system is a more convenient way for patients to book (and reschedule) appointments. Giving patients the ability to fill out electronic intake forms can reduce data entry errors, speed up the billing process and ensure that your billing department has accurate information about the patient.

Communicate about costs: From a patient’s perspective, medical costs are notoriously difficult to plan for. Health Care providers can help patients prepare by informing them of their payment responsibility upfront. Some providers even supply chargemaster prices, with a strong caveat that the amount could change after their insurer processes the visit.  When patients gain the ability to plan for these expenses, it can reduce stress in patients and build trust.

Smarter collections: The final step in the patient interaction is billing. Accepting online credit card payments makes it easy, convenient and safe for patients to pay their bills. When patients are late with payments, good communication is key to recovery, especially if the phone calls and letters help patients understand their options to catch up on their late bills. Finally, treat past-due patients with respect and compassion. When it comes time to send these accounts to a collection partner, experience and professionalism count.

Health care is a major expense for patients, which is why it’s important for clinics and practices to demonstrate the care just as much for a patient’s financial health as they do their physical health.

Brian Eggert is a business development specialist and writer for IC System. Moreinformation: https://bit.ly/2AZ010l

 

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How to Prevent Revenue Leakage in Your ASC

The healthcare reimbursement landscape has changed dramatically in just a few years. Just five years ago, healthcare providers could get 90% of their revenue from government payers (Medicare and Medicaid) and commercial insurance companies, while the remaining 10% comes from patient payments.

Today, patient payments can make up as much as 33% of provider revenue. Last year, enrollment in high-deductible health plans surged to include nearly half (47 percent) of those privately insured. 

The biggest challenge facing healthcare providers is the change from payer-based (insurance) revenue to consumer-driven reimbursement.

Many providers typically do not receive full reimbursement because patient collections are leaking throughout their revenue cycle. Some do not even detect the source or depth of their revenue loss.

Track Revenue Cycle Leaks 

It pays to know how much revenue you’re truly missing out on, and where they are coming from. Leakage could come from coding errors, manual payment and collection processes, unbilled revenue, and poor denials management.

It is important to conduct thorough audits that can find even fewer common areas where revenue leakage can occur. For example, unbilled insurance can lead to lost revenue for your ASC. To solve this problem, create reports that track unbilled insurance. In the same way, you can also have a report that tracks unbilled patients, including self-pay, promissory notes and patient balances after third-party payor responsibility is met. Insurance/eligibility verification also helps to increase clean claims rates, eliminate costly rework and accelerate reimbursement. Hence, it is good to have reports that show who has been verified.

It’s essential that each procedure performed in the practice becomes a claim in the billing process. If your billing company does not audit and validate the receipt of your interpretation reports, you easily could be losing 10% or more of your revenue, no matter how effectively the rest of your billing process performs.

Stop Patient Leakage

In 2018, a survey of healthcare executives conducted by Sage Growth Partners and Fibroblast revealed that 43% of the respondents report losing 10% or more of their annual revenue due to patient leakage while 23% don’t even know how much they are losing. Patient leakage translates to revenue leakage.

“Patient leakage” is the industry term when primary care physicians refer patients to out-of-system providers (instead of those in their network), resulting in significant business losses. It could also refer to patients seeking out other healthcare groups (out-of-network) for their care. 

Patient leakage also happens when a patient referral that should stay inside a health network ends up leaving for another or a patient that should receive care in the network doesn't follow through on the care.

Why does this affect an ASC’s bottom line? Your facility could lose considerable revenue and control when patients are being referred to other networks or to poorer performing providers within their own network. In a value-based care model, patient leakage can also pose a risk due to patients developing an event that is more acute than it should've been had they received care.

One of the key solutions to prevent patient leakage is better patient engagement and better care coordination. Modern and simple technologies like mobile EHRs, text and email messaging, and patient portals help create a personal connection with patients. In the long run, this builds loyalty and staying power. The provider-patient relationship is always on top of the list on what patients are looking for in their healthcare. 

Here are more suggestions:

Providers should specify referrals in their network. In the survey, client data indicates that 80% of the time, providers neglect to even specify who a patient should see.  

Follow up to see if patients received the care for which they were referred.


By preventing patient leakage and improving reporting and auditing, ASC’s can significantly drop their revenue leakage dramatically and protect their bottom line.

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Healthcare Providers Report Status of Revenue Cycle Management

Recent research shows some hospitals are lagging in implementing Revenue Cycle Management (RCM) solutions and consider outsourcing services only as a short-term solution.  “Twenty-six percent of all U.S. hospitals still do not have a viable, effective RCM solution in place, despite all the evidence of their positive impact on revenue, bottom line and efficiency,” according to a news release from Black Book Market Research LLC, which conducted the survey.

Respondents evaluated their technology services and solutions for the survey and of the “1,600 RCM modernization-delinquent hospitals,” according to the news release, 82 percent said they plan on making “value-based reimbursement decisions in 2019 without an advanced software implementation or outsourced partner.”

Results from a 2012 survey on RCM revealed that 35 percent of hospitals did not have an RCM strategy. The decline to 26 percent, “does indicate that there have been workable RCM IT plans adopted and new systems implemented by about 400 hospitals over the past six years.”

While a majority of respondents said they plan to implement advancement in RCM in-house, 85 percent also reported they would work with an outside firm for short-term direction, according to the news release.  

ACA International members interviewed for the January issue of Pulse said RCM is changing significantly based on technology and third-party agencies can provide valuable plan options to meet providers’ and patients’ needs.  (Read more industry insight on RCM in January issue of Pulse here https://www.acainternational.org/pulse.)

Additional findings from the Black Book Market Research Survey include:

Nearly 70 percent of providers said it takes a minimum of one month to collect a full balance from a patient.

They also seek to prevent claim denials through RCM.

However, challenges include staffing resources for RCM software and reimbursement.

More information: https://bit.ly/2T1UbSE

 

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3 Strategies for a Patient-Centered Revenue Cycle in 2019


As patient financial responsibility grows, the patient experience becomes very important in your revenue cycle. Aligning the healthcare revenue cycle with patient needs becomes the key to improving revenue collection and increasing patient volumes.

Here are 3 strategies to consider for your revenue cycle:

1.Personalize Financial Plans and Options

Each patient’s circumstances are unique and require a different approach in terms of financial services and counseling. Some patients can easily afford to pay their bills while others would need payment plans tailored to their ability to pay. 

The key to more personalization would be data on patient’s propensity to pay and also data gathered from patient engagement. Providers would then be able to predict the likelihood that patients will pay their out-of-pocket balances.

To achieve this, here are some of the things that a healthcare provider should do: 

Estimate patient out-of-pocket obligations.

Verify patient information and benefits eligibility. 

Predict the patient’s propensity to pay.

Offer payment plans tailored to each patient’s budget and ability to pay.

When appropriate, offer financial assistance programs especially to the uninsured.

2. Leverage Technology and Build Automated Systems 

Eliminating redundant manual processes allows providers to better connect with their patients to resolve financial issues. With automated systems, your staff can focus on patient interaction and communication.  Technology can make the revenue cycle management process more efficient and more accurate by reducing missed appointments, verifying insurance information, limiting claims denials, and reducing coding errors. 

Healthcare providers need to implement people and technology systems to automate and streamline workflows specific to patient needs. Here are some areas where automation can improve the patient experience:

Prioritizing staff workflow

Preventing eligibility denials

Gathering critical data

Self-pay vendor automation (daily account submission and real-time account adjustments)

3. Align Collection Strategies with Patient Consumerism

Healthcare providers can learn a lot from the techniques used by the retail industry in terms of billing and collections. Consumers are accustomed to flexible payment options, installment plans, and easy-to-understand bills. Consumers also know the price before they purchase services or items. But the key challenge in healthcare has always been clear price information (lack of price transparency).

As patient responsibility increases, understanding the cost of care prior to service will be critical to boosting patient collections. When patients are educated about their financial responsibility and given financial estimates, they are more likely prepared to pay in advance through point-of-service collections. 

To be able to transform the collection process, patient should be provided with the following: 

Online payment arrangements or online patient financing options 

Online (or mobile) bill pay

Price estimates based on the patient’s specific payer information

Guarantor-level billing (family’s statements)

Healthcare providers now rely on their patients as much as their payers with regards to their bottom line. Improving the patient experience and meeting consumer demands will be more crucial to improving the healthcare revenue cycle in the coming days. 

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Senators Cosponsor Legislation to End Surprise Medical Bills; Lower Healthcare Costs

Two U.S. senators recently introduced companion legislation that would help consumers manage health care costs and stop unexpected medical bills. U.S. Sen. Jeanne Shaheen, D-N.H., introduced the Reducing Costs for Out-of-Network Services Act of 2018 in October to “combat escalating out-of-pocket healthcare costs for uninsured patients and for patients in the individual health insurance market who receive out-of-network care,” according to a news release.

Cosponsor U.S. Sen. Maggie Hassan, D-N.H., introduced companion legislation to help end surprise medical bills for consumers as a result of receiving care they didn’t realize was considered out-of-network. “Shaheen’s legislation protects patients who are uninsured or in the individual health insurance market, while Hassan’s legislation protects patients with employer-sponsored health plans,” according to the news release.

“The bills that Senator Hassan and I are introducing would help fix chronic problems in our health care system by lowering costs for patients and increasing access to health services,” Shaheen said.  Shaheen’s bill, would cap the amount that hospitals and physicians could charge uninsured patients and out-of-network patients who have individual market coverage, according to the news release.

The Reducing Costs for Out-of- Network Services Act, it states, would:

Significantly reduce out-of-pocket costs for patients who have individual market health insurance and receive care from out-of-network hospitals and physicians;

Substantially reduce out-of-pocket costs for uninsured patients who could otherwise be charged very high “full charge” prices for hospital and physician services; and 

Reduce premiums for individual market health plans by improving individual market insurers’ ability to hold down negotiated provider payments and costs for in-network care.

Shaheen is also cosponsoring Hassan’s legislation, the No More Surprise Medical Bills Act of 2018 that will help “protect patients with medical emergencies from surprise billing by prohibiting hospitals and providers from charging more than the in-network amount.”

Hospitals would also be required to notify patients in non-emergency situations if their services are is out-of-network and obtain their consent before providing care.  In November, Hassan highlighted the importance of her legislation during a hearing with the Senate Health, Education, Labor Pensions Committee focused on health care costs.

“Studies have shown that nearly 1 in 5 visits involves care from providers who are out-of-network, and non-emergency situations often result in surprise medical bills as well,” Hassan said.  More information: https://bit.ly/2PfE0yY

 

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The Current Healthcare Payments Landscape and Future Opportunities

The overarching trend in today’s healthcare payments system is that high deductibles have become the norm and patients now have greater financial responsibility. Out-of-pocket expenses are projected to reach $608 billion in 2019 according to a report by Kalorama Information. Here are more trends defining the current healthcare payments landscape:

Confused Patients

Faced with higher deductibles more than ever before, patients are also struggling to understand their bills. A 2016 survey revealed that 72 percent of patients have received a medical bill that they didn’t understand. In addition, according to new research from NORC at the University of Chicago, 57 percent of US adults say they've received a surprise medical bill, and 82% say hospitals are "very" or "somewhat" responsible for their surprise bills,.

Antiquated Processes

Tasks like coverage verification, sending and receiving bills, and obtaining prior authorization (tasks which can all be automated) are costing healthcare providers $9.5 billion annually according to Business Insider Intelligence. These administrative tasks are also one of the reasons of increasing medical bills. Billions could be saved just by automating the antiquated processes in these areas.

Fortunately, healthcare providers and collection firms are investing in new digital payment solutions to combat these antiquated processes according to the latest survey by BillingTree. 54.5% of respondents plan on adding web payments (patient payment portals) within the next 12 months, and 27% plan to add “text to pay bill” (text payments) for the same period.

Paper Payment Systems

There’s still a lot of work to do in the healthcare payments landscape in terms of moving from paper to digital. In a recent InstaMed survey, 58 percent of providers said paper statements are the primary method for patient collections and a shocking 41 percent have not changed their billing process in more than 5 years. This is confirmed by the fact that 79 percent of patients said they have received a paper medical bill. 

Most interestingly, a study of large data breaches (affecting 500 patients or more) by researchers at the University of Central Florida and at the United States Air Force Joint Base in Charleston, South Carolina, revealed that paper and films were the most frequent location of breached data, occurring in 65 hospitals during the study period. While network servers were the least common location, but network server breaches affected the most patients overall.

Future Opportunities: Optimizing Your Revenue Cycle

A recent TransUnion analysis showed that 30% of self-pay accounts (those patients without health insurance or those that have a patient balance after insurance) will generate more than 80% of the self pay revenue collected by hospitals. This means that hospitals may be leaving millions on the table if their revenue cycle is less than optimal. An optimized revenue cycle ensures that earned revenue becomes paid revenue.

Why is this significant? The number of patients without health insurance increased to more than 12% at the end of 2017. In addition, Patient Balances after Insurance (PBAI) grew from 8% of the total bill responsibility in 2012 to 12.2% in 2017. The uninsured rate also grew from 10.9% in 2016 to 12.2% in 2017.

When healthcare providers focus too much on cost control measures, they are missing the bigger picture. As an example in 2018, cutting costs was the highest priority for 63% of hospital C-suite executives, according to a Premier survey.  But a recent Advisory Board study indicated that the typical 350-bed hospital may be leaving $22 million on the table by focusing on cutting costs over optimizing their revenue cycle.

Inefficiencies in the billing process is a huge problem in the healthcare industry but it also creates a massive market opportunity for new and existing healthcare payment tech players.

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Medical Debt Declines with Patients’ Age

Credit report data for more than four million Americans examined by researchers for Health Affairs shows medical bills in collections are declining among older consumers, but their medical spending is increasing.

According to the research, “the share of people with at least one medical bill in collections decreased nearly 40 percent from patients age 27 to 64.”  Overall, as of 2016, about 16 percent of consumers’ credit reports showed unpaid medical bills referred to collection agencies, Health Affairs reports.  While aging consumers’ medical bills in collections decline, spending increases.  For example, the mean medical spending for 2011-2015 ranges from $4,000 to $6,000 for consumers ages 70 to 80.

The authors of the Health Affairs study, Michael Batty, an economist at the Federal Reserve Board, Christa Gibbs, economist at the Bureau of Consumer Financial Protection, and Benedic Ippolito, an economist at the American Enterprise Institute, also found that “un-insurance rates tracked closely with total medical debt, with younger adults having both higher dollar amounts of medical debt and a higher likelihood of being uninsured.

However, the number of people who accumulate medical debt by age was less closely tied to insurance coverage rates.”  Read more on the study on the Health Affairs website: https://bit.ly/2o9cFmQ.

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